Functional results of the first human double-hand transplantation

被引:117
作者
Dubernard, JM
Petruzzo, P
Lanzetta, M
Parmentier, H
Martin, X
Dawahra, M
Hakim, NS
Owen, E
机构
[1] Hop Edouard Herriot, Serv Urol & Transplantat, F-69347 Lyon, France
[2] Hop Edouard Herriot, Serv Chirurg Transplantat, F-69347 Lyon, France
[3] Univ Cagliari, Dept Surg & Transplantat, Cagliari, Italy
[4] Univ Milan, San Gerardo Hosp, Milan, Italy
[5] Hop Edouard Herriot, Serv Orthoped & Chirurg Membre Super, F-69347 Lyon, France
[6] St Marys Univ, Transplant Unit, London, England
[7] Microsearch Fdn Australia & Outer Sydney Hand, Sydney, NSW, Australia
[8] Microsurg Unit, Sydney, NSW, Australia
关键词
D O I
10.1097/01.SLA.0000078945.70869.82
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Objective of this study was to analyze fifteen months after. surgery the sensorimotor recovery of the first human double hand transplantation. Summary Background Data: As for any organ transplantation the success of composite tissue allografts such as a double hand allograft depends on prevention of rejection and its functional recovery. Methods: The recipient was a 33-year-old man with bilateral amputation. Surgery included procurement of the upper extremities from a multiorgan cadaveric donor, preparation of the graft and recipient's stumps; then, bone fixation, arterial and venous anastomoses, nerve sutures, joining of tendons and muscles and skin closure. Rehabilitation program included physiotherapy, electrostimulation and occupational therapy. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil and, for induction, antithymocyte globulins and then CD25 monoclonal antibody were added. Sensorimotor recovery tests and functional magnetic resonance imaging (fMRI) were performed to assess functional return and cortical reorganization. All the results were classified according to Ipsen's classification. Results: No surgical complications occurred. Two episodes of skin acute rejection characterized by maculopapular lesions were completely reversed increasing steroid dose within 10 days. By fifteen months the sensorimotor recovery was encouraging and the life quality improved. fMRI showed that cortical hand representation progressively shifted from lateral to medial region in the motor cortex. Conclusion: Even though at present this double hand allograft, treated using a conventional immunosuppression, allowed to obtain results at least as good as those achieved in replanted upper extremities, longer follow-up will be necessary to demonstrate the final functional restoration.
引用
收藏
页码:128 / 136
页数:9
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